Carotid Eversion Endarterectomy: Should We Abandon the Standard Technique?

Abstract

Revascularization of the cervical internal carotid artery (ICA) provides excellent protection against ipsilateral ischemic stroke. It may be achieved through various surgical or endovascular techniques, although the optimal method for carotid revascularization still awaits crowning. Standard carotid endarterectomy is performed through a longitudinal arteriotomy, which is closed using either a simple suture or a patch. There is a slight but real risk of restenosis. Eversion endarterectomy of the ICA uses a transverse rather than a longitudinal arteriotomy, thus lessening the risk of restenosis while retaining the advantages of standard endarterectomy. However, eversion endarterectomy has not been widely accepted as the technique of choice of carotid revascularization. We have used eversion endarterectomy in our practice from 1979 to 1993 selectively in patients with an elongated ICA. Between 1993-1996 we prospectively evaluated it in unselected cases and then adopted CEE as our primary technique. This paper reports our technique and results and reviews the current literature on eversion endarterectomy to answer the question: should we abandon the standard technique?